Why myringoplasties fail? Impact of relevant clinical factors on the surgical outcome; a study from pakistan.

BACKGROUND: Myringoplasty is the reconstruction of the tympanic membrane by grafting. Success varies from 50-100%. A study was conducted to unveil the vital causes for failed myringoplasty with an aim to attenuate graft rejections and augment better outcomes. METHODS: It was descriptive case series in which data was retrospectively collected at a tertiary care hospital (Rawalpindi, Pakistan) from January 2009 to December 2018. First 600 consecutive patients who qualified for inclusion/ exclusion criteria, underwent myringoplasties were followed-up for 6 months. Graft Take/Failure, the main outcome variable, was correlated with relevant independent variables. Data was collected on a structured pro forma, approved by hospital ethical committee. Data was analysed using IBM-SPSS- 21.0. RESULTS: Out of 600, 164 (27.3%) had graft rejection; failure being significantly enhanced by increasing age (p<0.001), larger perforation (p-0.025), co-morbidities (p<0.001), especially diabetics (p=0.040) and Eustachian tube (p-0.016) dysfunction amongst among systemic and ENT diseases respectively, and discharge-free ear (Dry Ear) for <4 weeks (p<0.001); while best graft take was achieved with end-aural surgical technique (p=0.048). Gender (p-0.897) did not caste a significant impact on graft outcome. CONCLUSIONS: The results of various surgical approaches of myringoplasty are equitable. Proper socio-demographic and clinical evaluation can improve graft outcome, and this surgery shall be discouraged in patients with diabetes mellitus and defective Eustachian Tube functions.

Reproductive health issues in Pakistan; do myths take precedence over medical evidence?

OBJECTIVE: To analyse the prevalence of myths pertinent to healthcare issues of females of reproductive age. METHODS: This cross-sectional, simple descriptive, knowledge, attitude and practices-education research was conducted at the Combined Military Hospital, Peshawar, Pakistan, from February to August 2016. A 30-item self-designed questionnaire was applied, collecting demographic details and answers to 21 close-ended questions encompassing the prevalence of myths pertinent to reproductive health issues of women in Pakistan.Every question had three options, Yes(myth), No(correct answer) and Don't Know(unsure). SPSS 21 was used for data analysis. RESULTS: There were 594 participants in the study. The overall mean age was 35.11±12.711 years and the mean duration of education was 9.41±6.353 years. Besides, >50% answers positive for myths and <50% answers positive for myths were given by 326(54.9%) and 268(45.1%) respondents, respectively. The prevalence of myths was directly proportional to age (p=0.004), and inversely proportional to education (p<0.001) and socio-economic class(p<0.001); impact of education was stronger than socio-economic class(Pearson's chi-square being 74.189 and 48.672, respectively). Khyber Pakhtunkhwa-based respondents harboured more myths (p=0.024). There was no significant impact of marital status (p=0.099). CONCLUSIONS: The participants held significant amount of myths regarding health issues in reproductive age.

Green fabricated CuO nanobullets via Olea europaea leaf extract shows auspicious antimicrobial potential.

In present investigation, copper oxide (CuO) nanostructures have been prepared via green chemistry. Olea europaea leaf extract act as strong chelating agent for tailoring physical as well as bio-medical characteristics of CuO at the nano-size. Physical characterisation such as scanning electron microscope analysis depicts the formation of homogenised spherical shape nanoparticles (NPs) with average size of 42 nm. X-ray diffraction and Fourier transform infrared spectroscopy further confirmed the crystalline pure phase and monoclinic structure. High performance liquid chromatography (HPLC) testing is performed to evaluate the relative concentration of bioactive molecules in the O. europaea leaf extract. From HPLC results capping action of organic molecules around CuO-NPs is hypothesised. The antimicrobial potency of biosynthesised CuO-NPs have been evaluated using colony forming unit (CFU) counting assay and disc diffusion method which shows a significant zone of inhibition against bacterial and fungal strains may be highly potential for future antimicrobial pharmaceutics. Furthermore, reduction of various precursors by plant extract will reduce environmental impact over chemical synthesis.

Functional Endoscopic Sinus Surgery as a primary modality of treatment for primary and recurrent nasal polyposis.

OBJECTIVES: To describe the efficacy of Functional Endoscopic Sinus Surgery(FESS) in our set up in comparison with other published studies to treat primary and recurrent nasal polyposis. METHOD: This descriptive study was conducted in 02 years at Ear Nose Throat Department Combined Military Hospital (CMH) Multan from October 2013 to October 2015. Convenient sample comprising 116 patients of both sexes of age group from 18 to 60 years were selected from ENT Out Patient Department, with documented diagnosis of nasal polyposis that underwent functional endoscopic sinus surgery. Out of 116 patients, 15 (12.9%) had recurrent nasal polyposis while 101 (87.1%) had primary nasal polyposis. Patients were assessed clinically. Preoperative nasal endoscopy and CT scan of nose and paranasal sinuses were performed in every patient to assess the extent of disease and evaluate the surgical anatomy. Patients were followed up 03 monthly, 06 monthly and after 01 year. Clinical signs of nasal polyposis were evaluated by nasal endoscopy at each follow up visit. RESULTS: There were 116 patients with documented diagnosis of nasal polyposis. Among these, 75 (64.7%) were male and 41 (35.3%) were female patients. Mean age of presentation in males was 39.1 years and that of females was 36.7 years. Only 15 patients (12.9%) developed recurrent disease within a year. CONCLUSION: Functional endoscopic sinus surgery is preferred as a primary treatment modality for primary and recurrent nasal polyposis. Mucosal polyps can be carefully debrided, the natural ostia enlarged, the ethmoid sinuses are unroofed, and sphenoid sinuses are opened in nasal cavity and sinus nasal mucosa is mostly preserved due to excellent visualization and surgical technique. Improvement in symptoms with minimal chance of recurrence may be expected in more than 90% patients.

Comparison of permeatal medial placement of graft without raising the tympano-meatal flaps to conventional methods of myringoplasty: An experience at tertiary care hospital in Pakistan.

OBJECTIVE: To compare the results of permeatal approach without raising the tympano-meatal flap to end-aural or post-aural approach in myringoplasty. METHODS: This Quasi-experimental study was carried out in CMH (Combined Military Hospital) Peshawar, from August 2006 to July 2013. Three hundred fifty patients of chronic suppurative otitis media (CSOM) with dry central; small, medium and large perforations were selected. They were divided into two groups depending upon the type of approach. In Group-A (n-200); permeatal approach without raising tympano-meatal flap was used; while in Group-B (n-150) end-aural or post-aural approach was used. Subjects were followed up for two years; graft take was checked regularly by examinations of ear under microscope. Data was collected on structured Performa and analysed by SPSS-17. RESULTS: Male and female were 74% and 26% respectively; Age ranged from 15 to 46 Years. There was no significant difference in the graft success at the end of two years in Group-A(80%) and Group-B(85%) (p-0.261). Type of approach had a significant impact on duration of surgery(p<0.001) and post-operative recovery time(p<0.001). CONCLUSION: The permeatal approach and end-aural/post-aural approach had almost equal graft success rates, but former is more useful as it causes lesser morbidity, decreased post-operative hospital stay and reduced operative time. It is under-utilized and should be employed more frequently.

Son Preference in Pakistan; A Myth or Reality.

OBJECTIVE: To analyze desire for sons/daughters among ladies of Peshawar, Pakistan, with a view to rule out son preference and to study impact of various demographic characteristics on the subject. METHODS: Cross-sectional descriptive study conducted at Combined Military Hospital, Peshawar, from August 2015 - January 2016; sampling technique was random/probability/non-purposive. Self-designed questionnaire was utilized; carrying questions pertinent to desire for sons/daughters during marital life, and demographic details. Data analyzed via descriptive analysis (SPSS-21), expressed as frequencies/percentages and mean ± standard deviation(minimum/maximum). Sons and daughters desired (dependent variables) were cross-tabulated with independent variables. RESULTS: Response rate was 63.25% (n-506). Data revealed following: Sons desired 3.05±2.061(1/12); Daughters desired 1.15±0.767(0/4); 6.1%(n-31) and 0.6%(n-3) desired infinite number of sons and daughters respectively, 18.2%(n-92) did not desire to have even one daughter, while 2.2%(n-11) considered it immaterial to have daughters or sons. There was a significant relation between sons desired and client's education (p<0.001), husband's education (p<0.001) and socioeconomic class (p<0.001). There was no significant impact of religion (p-0.142) on desire for sons. Impact of independent variables on daughters desired was similar but less pronounced. CONCLUSION: There was candid son preference among the respondents. Gender discrimination can be attenuated by adequately addressing son preference at all tiers.

Trends of contraception among ladies of local population in Pakistan; why, how, when and what?

OBJECTIVE: To analyze trends of use of methods of contraception along with study of impact of various demographic and social factors on contraception in Peshawar, Pakistan. METHODS: A cross-sectional descriptive study with random purposive sampling was conducted at Combined Military Hospital Peshawar, from Mar 2015-Nov 2015. Self-designed questionnaire with demographic details and questions pertinent to contraceptive practices was utilized as study instrument. Females reporting to concerned hospital for contraceptive advice and prescription were distributed with questionnaire and written informed consent form. Formal approval was taken from ethical committee of hospital. Data was analyzed via descriptive analysis (SPSS-21), qualitative data was expressed as frequencies and percentages; quantitative as mean±standard deviation (SD). Main outcome variable i-e contraceptive device used; was cross-tabulated with independent variables. RESULTS: Response rate was 53.2% (n-426). Usage of contraceptive device was as follows; 51.2% Nil, 9.4% barriers, 22.3% oral/injectable hormones, 13.4% IUCDs, 3.8% sterilization. There was a strong relationship between type of contraceptives used and age (p<0.001), client's education (p<0.001), husband's education (p<0.001), number of children (p<0.001), religion (p0.013), socioeconomic class (p<0.001), and religious beliefs about use of contraceptives (p<0.001). More Muslims considered contraception irreligious than non-Muslims (p 0.02). There was no significant impact of husbands' pressure to not to use contraceptives on type of contraception practised (p 0.114). CONCLUSION: Contraceptive devices are under-utilized in the study participants. Multidisciplinary approach should be applied to enhance client education, awareness and counseling to utilize these devices more appropriately and regularly.

Pharyngeal Pouch Co-existing with Thyroid Mass: A Rare Presentation.

A 60-year male presented with a 4-year history of a mass in the lower third of the neck, which had gradually increased in size. On initial examination, it was considered a thyroid mass. On detailed examination, another mass was found in the upper neck which was doughy in consistency and reducible in size. With available investigations, he was diagnosed as a thyroid mass associated with pharyngeal pouch. On exploration of the neck, the whole mass revealed to be a pharyngeal pouch. We have discussed the patho-physiology of the pharyngeal pouch and reviewed the literature in detail.

Olfactory neuroblastoma presenting as bleeding polyp.

Malignant tumours of the nasal cavity are rare. Olfactory neuroblastomas (esthesioneuroblastomas) account for only 6% of these neoplasms. Fewer than 1,000 cases have been reported in the literature since this tumour was first described more than 75 years ago. A 13 year old girl presented with bleeding nasal polyp to ENT Department. She was operated as there were no signs of tumour the histopathology report revealed it to be olfactory neuroblastoma. As there was no intracranial extension she was given postoperative radiotherapy.